Effectiveness in Disease and Injury Prevention
Child Passenger Restraint Use and Motor-Vehicle-Related
Fatalities Among Children -- United States, 1982 - 1990
Although in recent years the increase in child safety seat use
in the United States has saved lives of and prevented injuries to
infants (children aged less than or equal to 1 year) and toddlers
(children aged 1-4 years), the leading cause of death among U.S.
children aged 1-4 years continues to be injuries to motor-vehicle
occupants (1). These injuries account for the largest number of
years of potential life lost before age 65 and the highest costs
associated with pediatric injury (2). This report, based on data
from the Fatal Accident Reporting System (FARS) (maintained by the
National Highway Traffic Safety Administration), summarizes overall
trends from 1982 through 1990 for motor-vehicle-related fatalities
among children and lives saved by child passenger restraint use.
In the United States, in 1990, child safety seats were used
for an estimated 83% of infants and 84% of toddlers, compared with
60% and 38%, respectively, in 1983 (Table 1) (3). Despite this
level of use, 500-700 infants and toddlers died each year from 1983
through 1990 in traffic crashes (4). In 1990, FARS reported that
624 children less than 5 years of age were killed in motor-vehicle
crashes, of whom 70% were not restrained. Compared with children in
the general population, fatally injured children and survivors of
fatal crashes (i.e., crashes in which at least one fatality
occurred within 30 days of the crash) were substantially less
likely to have been restrained by child safety seats (Table 1).
Use of child safety seats reduced the likelihood of fatal
injury by an estimated 69% for infants and 47% for toddlers. Adult
safety belts used for toddlers reduced the likelihood of fatal
injury by 36% (5-7). Based on these estimates, from 1982 through
1990, the use of restraints (both child safety seats and adult
safety belts) saved an estimated total of 1546 lives of young
children in passenger-vehicle crashes.
Reported by: TM Klein, MC Walz, National Center for Statistics and
Analysis, Research and Development, National Highway Traffic Safety
Administration, US Dept of Transportation. Unintentional Injuries
Section, Epidemiology Br, Div of Injury Control, National Center
for Environmental Health and Injury Control, CDC.
Editorial Note
Editorial Note: From 1985 through 1989, the number of fatalities
among passenger-vehicle occupants less than 5 years of age
increased steadily. Most of the increase appeared to be related to
increased on-the-road exposure of children rather than to decreased
child restraint use, increased improper use, or child restraint
deficiencies (4). In addition, young children involved in fatal
crashes may not be representative of the general population:
children who are not restrained may be at greater risk for
involvement in a potentially fatal crash (5)--a problem also
characteristic of the high-risk adult population (8).
In 1978, Tennessee became the first state to implement a law
requiring restraint of children in motor vehicles. By 1985, all 50
states and the District of Columbia had such mandatory-use laws in
effect (9). These laws vary by state, some requiring use only until
the child's first birthday, others until age 5 years. Although most
states require that children be protected by child safety seats
until the third or fourth birthday, some exceptions are permitted
(e.g., travel in vehicles other than a parent's). The average fine
for persons who fail to use safety restraints for children is
approximately $40 (range: $10-$500); however, this fine is usually
waived on proof of safety seat acquisition. A recent assessment of
child restraint laws indicates their immediate benefit is to reduce
fatalities by 9% (10). Because laws contribute to an increased use
of restraints for young children and an increased awareness of
restraint use in general, the potential benefits (e.g., reduction
in fatalities and injuries in motor-vehicle crashes) may increase
over time.
Further reductions in child crash fatalities will require
education and motivation of parents to use child safety seats and
safety belts. In addition, high-risk groups (i.e., those most
likely to be involved in crashes) must be identified and targeted
for intervention to increase the use of child safety seats.
References
NCHS. Health--United States, 1990. Hyattsville, Maryland: US
Department of Health and Human Services, Public Health Service,
CDC, 1991.
CDC. Childhood injuries in the United States. Am J Dis Child
1990;144:627-46.
National Highway Traffic Safety Administration. Occupant
protection trends in 19 cities. Washington, DC: US Department of
Transportation, National Highway Traffic Safety Administration,
1991.
Klein TM, Van Dyke J, Surti J, Walz M. An investigation of the
increase in child passenger fatalities since 1984. Washington, DC:
US Department of Transportation, National Highway Traffic Safety
Administration, 1990; report no. DOT-HS-807-679.
Partyka SC. Lives saved by child restraints from 1982 through
1987. Washington, DC: US Department of Transportation, National
Highway Traffic Safety Administration, 1988; report no.
DOT-HS-807-371.
Partyka SC. Papers on child restraints: effectiveness and use.
Washington, DC: US Department of Transportation, National Highway
Traffic Safety Administration, 1988; report no. DOT-HS-807-286.
Kahane CJ. An evaluation of child passenger safety: the
effectiveness and benefits of safety seats. Washington, DC: US
Department of Transportation, National Highway Traffic Safety
Administration, 1986; report no. DOT-HS-806-890.
Chorba TL. Assessing technologies for preventing injuries in
motor-vehicle crashes. Journal of Technology Assessment in Health
Care 1991;7:294-312.
National Highway Traffic Safety Administration. Buckle up for
love. Washington, DC: US Department of Transportation, National
Highway Traffic Safety Administration, 1990; report no.
DOT-HS-807-650.
Partyka SC. Effect of child occupant protection laws on
fatalities. Washington, DC: US Department of Transportation,
National Highway Traffic Safety Administration, 1989; report no.
DOT-HS-807-453.
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